Relationship between size and other radiological features with malignancy in pulmonary nodules; follow-up or pathological diagnosis?

Pulmonary lesions can be detected even at a few millimeters in size, allowing for detailed assessment of their radiological features. This study aims to determine the most appropriate approach for nodules detected by computed tomography. A total of 526 patients, who underwent surgery for pulmonary nodules or masses and had pathological diagnoses, were included in the study. Demographic features, clinical history, and surgery-related data of the patients were assessed by a thoracic surgeon, whereas radiological features were evaluated by a radiologist. Of the patients, 147 were female and 379 were male. The mean age was 63 years (min 15, max 89), and the average lesion size was 22 mm (min 4, max 116). Postoperative analysis revealed 132 benign lesions (25.1%), 380 malignant (72.2%), and 14 metastases (2.7%). Among 347 patients, the nodule size was below 30 mm. Malignant nodules showed a higher median age and larger lesion size (P < .05 for both). Lesion contour, calcification, pleural tail, changes in lesion during follow-up, presence of emphysema, enlarged lymph nodes, history of malignancy, and smoking were statistically significant in determining the nature of the detected lesion. The clinical and radiological characteristics of patients can be utilized to determine the risk of malignancy in detected nodules. Even if the nodule size is small, histopathological diagnosis may be a more suitable option for high-risk patients instead of radiological follow-up.